Archive | 2021
PERI-OPERATIVE RISK FACTORS FOR LONG TERM INTELLIGENCE IN CHILDREN WITH POSTOPERATIVE CEREBELLAR MUTISM SYNDROME AFTER MEDULLOBLASTOMA SURGERY
Abstract
Objective: 7-50% of children with medulloblastoma (MB) develop\npostoperative cerebellar mutism syndrome (pCMS). pCMS has a short-term\nnegative impact on intelligence, but results on long-term outcomes are\ncontradictory. The aim of this study was to assess long-term effects of\npCMS in MB patients on aspects of intelligence (IQ) and its\nperioperative risk factors. Methods: In this single centre retrospective\ncohort study, 31 children with MB were included of which 14 had pCMS.\nPeri-operative risk factors included brainstem invasion, vermis\nincision, pre-and post-operative hydrocephalus, tumor size, duration and\nseverity of pCMS, neurological symptoms on day 10 after surgery, mean\nbody temperature (BT) on days 1-4 post surgery, and age at resection.\nAge appropriate Wechsler Intelligence tests were assessed within a\nstructured follow up programme. Results: No significant differences in\nIQ scores were found between pCMS and non pCMS groups. The pCMS group\nhad a clinically relevant difference of 10 points when compared to age\nnorms on verbal IQ (VIQ). Bilateral pyramidal and swallowing problems\nwere risk factors for lower performance in this group. In the overall\ngroup, tumor size, younger age at surgery, and raised mean BT on days\n1-4 post-surgery were negatively correlated with aspects of IQ.\nConclusions: We found a clinically significant reduction of VIQ in the\npCMS patient group. pCMS patients with a larger tumor size, younger age\nat surgery, a higher mean BT in the first days after surgery, bilateral\npyramidal symptoms, and swallowing problems 10 days post-surgery are\nmore at risk for VIQ deficits at long-term.